House S07EP22 “After Hours”
In the penultimate episode for Season 7, we are treated with a non-standard way of telling the story, with very little of the medical mysteries happening in the hospital. In our “A” plot, House has to deal with the ramifications of his medical experimentation from last week. In the “B” plot, Thirteen receives a visitor from her time in prison. And in the “C” plot, Taub comes to terms with the fact that he’s a grown up.
We know that short of the writers pulling a “Kutner” and eliminating a main character wholesale, House and Taub will come through OK, and they apparently do by the end. We’ll focus instead on the story of Darrien, a ex-convict who befriended Thirteen during her recent incarceration this season. Darrien shows up with a nasty knife cut, and just wants to be stitched up, but it quickly becomes apparent that she is far sicker than her copious bleeding would suggest.
It turns out that Darrien was a police officer who shot an unarmed suspect, and is wracked with guilt over the incident. She developed destructive behavior that landed her in prison, and in the interim became infected with Hepatitis C virus. She was consequently treated with interferon therapy for the viral infection, however all medical records indicated that she had long term, chronic Hep C infection. The twist in this plot was that, although she had hepatitis, it was relatively recent and a second infection was exacerbating the hepatitis symptoms and making it appear that she had long term Hepatitis C infection. The second infection was from Entamoeba histolytica, a protozoan that is responsible for amoebic dysentery. Entamoeba infections are readily cleared up with metronidazole once properly diagnosed, and this treatment resolves Darrien’s medical crisis.
The principle at work in this infection is microbial synergism, not to be confused with microbial antagonism where the normal microbiota that plays a significant role in protecting the human body from infection. In synergism, the combination of the two etiologic agents leads to a more significant, and different, set of signs and symptoms than would be seen by either of the single pathogens alone. This would hinder the diagnostic process, and complicate treatments if the root causes are not teased out. An example of this process that is frequently mentioned in introductory microbiology is the synergism between Hepatitis virus and the toxemia due to Aspergillus infection. This mold makes a very potent toxin called aflatoxin which damages the liver. Concurrent infection by Hepatitis C virus greatly increases the risk of developing liver carcinoma.